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Smoking cessation treatment in primary care: prospective cohort study
  1. A Wilson1,
  2. J Hippisley-Cox2,
  3. C Coupland2,
  4. T Coleman2,
  5. J Britton3,
  6. S Barrett2
  1. 1Department of Health Sciences, University of Leicester, Leicester, UK
  2. 2Division of Primary Care, University of Nottingham, Nottingham, UK
  3. 3Division of Respiratory Medicine, University of Nottingham
  1. Correspondence to:
 Dr Andrew Wilson
 Department of Health Sciences, Division of General Practice & PHC, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; aw7le.ac.uk

Abstract

Objective: To compare the characteristics of smokers who do and do not receive smoking cessation treatment in primary care.

Design: Prospective cohort study using practices registered with the pilot QRESEARCH database.

Setting: 156 550 patients aged 18 years and over from 39 general practices located within four strategic health authorities, representing the former Trent Region, UK.

Subjects: Patients registered with practices between 1 April 2001 and 31 March 2003 aged 18 years and over who were identified as smokers before the two year study period.

Outcome: Prescription for smoking cessation treatment (nicotine replacement therapy (NRT) or bupropion) in the two year study period.

Variables: Age, sex, deprivation score, co-morbidity.

Results: Of the 29 492 patients recorded as current smokers at the start of the study period 1892 (6.4%) were given prescriptions for smoking cessation treatment during the subsequent two years. Of these, 1378 (72.8%) were given NRT alone, 406 (21.5%) bupropion alone, and 108 (5.7%) both treatments. Smokers were more likely to receive smoking cessation treatment if they lived in the most deprived areas (odds ratio (OR) for the most relative to the least deprived fifth, adjusted for sex, age, and co-morbidity, 1.50, 95% confidence interval (CI) 1.26 to 1.78), and if they were aged 25–74 years compared to 18–24 years or 75 and over. Smokers with co-morbidity were also more likely to receive smoking cessation treatment. Smokers were less likely to receive smoking cessation treatment if they were male (adjusted OR 0.68, 95% CI 0.62 to 0.75).

Conclusion: The low proportion of smokers being prescribed these products strongly suggests that a major public health opportunity to prevent smoking related illness is being missed.

  • CI, confidence interval
  • COPD, chronic obstructive pulmonary disease
  • GP, general practitioner
  • NHS, National Health Service
  • NICE, National Institute for Clinical Excellence
  • NRT, nicotine replacement therapy
  • OR, odds ratio
  • PCT, primary care trust
  • PPA, Prescription Pricing Authority
  • TIA, transient ischaemic attack
  • bupropion
  • cessation
  • nicotine replacement therapy
  • primary care
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Footnotes

  • Funding: Access to data was funded by a grant from the Health Development Agency. The analyses and report were done without any additional funding.

  • Competing interests: AW, none; JHC, none; CC, none; TC has been paid (once) for speaking by Glaxo-Smith Kline and for consultancy work by Pharmacia 2002. JB has received an honorarium from Glaxo-SmithKline and had research funded by Pharmacia; SB, none

  • Ethical approval: Trent Multi-Centre Research Ethics Committee

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